This research trial studies F-18 16 alpha-fluoroestradiol (FES)-positron emission tomography (PET)/computed tomography (CT) in predicting response to treatment in patients with estrogen receptor-positive breast cancer that that does not respond to endocrine treatment (endocrine refractory) and has come back (recurrent) or has spread to other parts of the body (metastatic). FES-PET/CT is a type of scan that measures the amount of estrogen receptors in the breast cancer, which may be a sign of how the cancer is responding to treatment. If the levels of estrogen receptors can predict the cancer's response to treatment, and can be measured using FES-PET/CT scans, doctors may be able to choose a treatment that works best for each patient and measure how well the patient is responding without performing surgery for a biopsy.
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT02409316.
PRIMARY OBJECTIVES:
I. Evaluate [18F]FES (F-18 16 alpha-fluoroestradiol) PET/CT uptake as a predictor of progression free survival in endocrine refractory recurrent or metastatic breast cancer patients starting a new therapy regimen including endocrine targeted therapy.
SECONDARY OBJECTIVES:
I. Correlate [18F]FES uptake measures with standard immunohistochemistry (IHC) (e.g. estrogen receptor [ER], progesterone receptor [PR], human epidermal growth factor receptor 2 [HER2-neu]) and experimental pathology markers available from primary and/or metastatic tissue.
II. Evaluate the utility of combined [18F]FES PET/CT and fludeoxyglucose F-18 (FDG) PET/CT in identifying heterogeneity of estrogen receptor expression and functionality in metastatic breast cancer.
III. Evaluate overall survival in patients receiving regimens containing endocrine targeted therapy.
IV. Compare FES uptake measures at baseline and progression in patients receiving additional endocrine targeted therapy.
V. Correlate FES uptake measures with number of ER+ circulating tumor cells (CTCs) and ratio of ER+ to ER- CTCs.
OUTLINE:
Patients receive F-18 16 alpha-fluoroestradiol intravenously (IV) and undergo PET/CT at baseline. Patients may also undergo an additional PET/CT at clinical evidence of progression of disease.
After completion of study, patients are followed up once per month.
Lead OrganizationUniversity of Pennsylvania/Abramson Cancer Center
Principal InvestigatorDavid A. Mankoff